Medicare Open Enrollment: Do your homework

Marci Vandersluis is a care manager assisting older adults and writes the Embrace Your Aging column. TY GREENLEES/STAFF/FILE

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Marci Vandersluis is a care manager assisting older adults and writes the Embrace Your Aging column. TY GREENLEES/STAFF/FILE

Yep, the Medicare annual open enrollment period doors have opened. From Oct. 15 through Dec. 7, current or new Medicare recipients with Parts A and B have the opportunity for insurance “redo.”

More specifically during this time one can join or drop a Part D prescription plan, and change from Medicare Advantage plan to another Medicare Advantage Plan. A Medicare recipient may also switch from their current Medicare Advantage Plan to Original Medicare (Parts A and B).

Very generally, Medicare Advantage Plans cover the services that Medicare A and B provide. As well many of these plans offer some additional services including health and wellness programs and prescription drug coverage. Medicare A helps to cover the costs for an inpatient hospital stay, hospice care and rehabilitation in a skilled nursing facility following an inpatient hospital admission. Part B insurance is used for out patient physician and therapy visits, some durable medical supplies and a limited number of medications.

If changing from a Medicare Advantage Plan to Original Medicare it is important to note that a Part D prescription plan will need to be purchased. Also, since Part B insurance does not provide comprehensive coverage, many people will opt to purchase a Medigap private insurance plan to help with co pays and deductibles not covered by original Medicare. It is important to note, however, that there may be financial and eligibility consequences when choosing this insurance outside of the six-month period that begins when turning 65 and enrolling in Medicare Part B. Should a change be made, it is reassuring to know that, between January 1 and February 14th if enrolled in a Medicare Advantage plan, there is the option to return to Original Medicare but not into another Medicare Advantage plan.

There are some changes to Medicare that will apply to all Medicare recipients regardless of their plan. Most notably, to help reduce fraud and identity theft, Social Security numbers will no longer be printed on the Medicare identification card.

Another plus is that recipients who have limited drug coverage as a result of being in the donut hole will find lower out of pocket costs until out of this gap. Less encouraging to note for many beneficiaries living in rural areas is that according to a recent report from the Kaiser Family foundation, 147 counties, across 14 states have no Medicare Advantage insurer this year.

Even if satisfied with a current plan do not remain complacent. Rather, take some time to learn about other plans. Because there is often fluctuation with providers, contact your physician and pharmacy to confirm that they are in the network and will remain so 2018. This is particularly important if considering a change to a Medicare Advantage Plan. If you are a big traveler and considering a change from Medicare to a Medicare Advantage plan, review with a plan representative potential out of pocket costs vs. original Medicare. Spend time talking with a representative from this plan to learn more about specific benefits, including coverage criteria for rehabilitation stay in a skilled nursing facility. Take advantage of the Medicare Plan finder on the Medicare website to review medications, along with coverage most suited to personal preferences. A call can also be made to the Ohio Senior Health Insurance Information Program (OSHIIP) for free Medicare information or attend a local Medicare Check up day (see below).

Marci Vandersluis is a licensed social worker and has a master’s degree in gerontology. She is employed as a care manager assisting older adults in the community connect with needed services. Email: marcirobinvandersluis@gmail.com.


Learn more

Medicare: 1-800-633-4227 (1-800-MEDICARE). Have your Medicare number nearby when you call.

Medicare Plan Finder: www.medicare.gov/find-a-plan/questions/home.aspx

Ohio Senior Health Insurance information Program (OSHIIP): 800-686-1526 or www.insurance.ohio.gov/Consumer/OSHIIP/Documents/whatisoshiip.pdf

Medicare Check Up Days local meetings: www.insurance.ohio.gov/Consumer/OSHIIP/SitePages/CheckUpDays.aspx

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